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2016
Go for the Gold
Well-Being Challenge
Registration
1.
Please list contact information:
First Name
Last Name
Work Department
Work Location
Email Address
Email Address for verification
2.
How do you rate the following health components in your life?
Poor
Average
Excellent
Drinking water, staying hydrated 64 oz per day
Poor
Average
Excellent
Nutrition, eating 5 servings of fruits and vegetables daily
Poor
Average
Excellent
Stretching, incorporating 10 minutes of flexibility when exercising
Poor
Average
Excellent
Strength training, incorporating resistance training exercises 3 times per week
Poor
Average
Excellent
Overall fitness level
Poor
Average
Excellent
3.
In a typical week, how many days do you exercise?
I don't regularly exercise
Once a week
2 to 4 days a week
5 to 7 days a week
4.
How many minutes of exercise do you complete each week?
0 minutes, I do not exercise
60 minutes or less per week
90 minutes or more per week
150 minutes or more per week
5.
At what intensity do you most often exercise?
Low intensity
Moderate intensity
High intensity, breathless
I do not exercise
Other (please specify)
6.
How do you rate support/encouragement for physical activity at work?
Low, not supported.
Medium, I feel I have opportunity or encouragement to be active and my co-workers and I encourage each other.
High, I always have support at work, we talk about well-being and our goals often.
7.
What do you hope to achieve or gain by participating in the
Go for the Gold
well-being challenge?
Improve fitness level
Spend more minutes each week being physically active
Education, learning the recommendations for an overall active and fit lifestyle
Fun, amplify unity and stronger connection with co-workers and organization
Other
8.
Please share other well-being goals.
